Lifetime Diabetes Expenditures Varies Greatly Based on Age of Diagnosis, Sex, Race

Although the Medicare Diabetes Prevention Program has been proven to be beneficial in reducing body weight with the potential to prevent or delay type 2 diabetes (T2D) among older individuals, there is little known about the economic benefits of the program.

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In a study of those with Medicare, the incidence of T2D was associated with approximately $30,000 to $98,000 excess lifetime medical expenditures, which varied widely by age of diagnosis, sex, and race, according to a presentation at the American Diabetes Association 83rd Scientific Sessions.

“Our estimates can be used to measure the economic benefit from the diabetes prevention program in the Medicare population,” Yu Wang, PhD, from the CDC, said in the presentation.

Investigators aimed to estimate the lifetime incremental medical expenditures that are associated with T2D among individuals who have Medicare at the time of diagnosis. They also wanted to identify the expenditure disparities across sex, racial, and ethnic subgroups.

Individuals included in the study were aged 67 years or older who were from the Centers for Medicare and Medicaid Services Chronic Conditions Data Warehouse. Data were collected from 2001 to 2019. Participants had 1 inpatient or 2 outpatient claims with a diabetes diagnosis within 2 years, but not in the 2 years prior to the study, according to Wang.

The incremental lifetime medical cost by age of diagnosis was calculated using the difference between the survival-adjusted lifetime medical spending incident cohort and those in the non-diabetes cohort. Investigators also used the annual medical spending, the survival rate, and the aggregated survival adjusted annual cost.

“For someone who is diagnosed with diabetes at age 70, this [individual] is supposed to live with diagnosed diabetes of 13.26 more years, which is 1.61 years [less] than in the non-diabetes cohort,” Wang said in the presentation.

Investigators also found that the disparity was 10.52 years and 0.73 year for those aged 75; 8.69 and 4.1 for those aged 80; and 6.66 and 0.29 for those aged 85, respectively. This corresponded with $220,853 of lifetime costs with diabetes for those aged 70, $193,986 at age 75, $162,915 at age 80, and $127,804 at age 85. The lifetime incremental spending was $63,750, $55,251, $44,784, and $34,483, respectively.

Additionally, investigators determined the incremental lifetime cost by age of diagnosis, sex, and race. For those age 70, there was a lifetime cost of $58,998 for White females; $57,082 for White males; $97,745 for Black females; and $85,926 for Black males.

Similarly, it was found that for those age 70, the costs were $51,157, $50,104, $84,457, and $75,593, respectively. For those age 80, the cost was $40,444, $40,558, $72,003, and $60,979, respectively, and $30,529, $32,490, $54,565, and $48,187, respectively, for those age 85.

Wang said that the lifetime cost is much lower for the White population compared with the Black population.

“One possible explanation would be that when the Black population gets diagnosed, he or she might be having more [events] of diabetes already,” Wang said. “If we compare across sex groups within the same race, you can see that in the White population the female cost was similar to the male group.”

Wang added that in the Black population, the cost was higher across the sex groups.

Additionally, Wang said that the annual survival-adjusted incremental medical expenditure was high around diagnosis, but sharply decreased and stabilized after diagnosis. After stabilization, the cost continued to decrease overtime.

Wang hopes that the estimates in the study can be used to measure the economic benefit from diabetes prevention in these populations.

Reference

Wang Y. Lifetime medical spending for type 2 diabetes among Medicare beneficiaries in the United States. Presented at: American Diabetes Association 83rd Annual Scientific Sessions. San Diego, CA. June 23, 2023. Accessed July 5, 2023.